Your patients’ Acthar prescription is only available through specialty pharmacy distribution and cannot be filled at a retail pharmacy. To get the prescription and reimbursement process started, download, fill out, and fax in the referral form below so the Acthar Support & Access Program (A.S.A.P.) can begin your request.
To avoid processing delays, please make sure:
If you have any questions or need assistance filling out your form, contact A.S.A.P.PHONE: 1-888-435-2284
Monday–Friday, 8 AM–8 PM ET
A.S.A.P. will keep you and your patient informed about the delivery status of their Acthar prescription.
H.P. Acthar® Gel (repository corticotropin injection) is indicated for the treatment of acute exacerbations of multiple sclerosis in adults. Controlled clinical trials have shown Acthar to be effective in speeding the resolution of acute exacerbations of multiple sclerosis. However, there is no evidence that it affects the ultimate outcome or natural history of the disease.
Warnings and Precautions
Please see full Prescribing Information.